Статті в журналах: "Necrotizing enterocolitis, infants, treatment"

1

Black, Virginia D., Carol M. Rumack, Lula O. Lubchenco, and Beverly L. Koops. "Gastrointestinal Injury in Polycythemic Term Infants." Pediatrics 76, no. 2 (August 1, 1985): 225–31. http://dx.doi.org/10.1542/peds.76.2.225.

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Necrotizing enterocolitis is uncommon among term infants. In this group, necrotizing enterocolitis has been associated with two risk factors: polycythemia and umbilical catheterization. During a randomized trial of partial plasma exchange transfusion for treatment of polycythemia, an increased risk of gastrointestinal problems was noted. Eight hyperviscous patients treated with partial plasma exchange transfusion, no symptomatically treated patients, and no control infants developed typical necrotizing enterocolitis (blood in the stools, pneumatosis, and systemic signs). The incidence of necrotizing enterocolitis was significantly greater among patients treated with exchange transfusion compared with patients treated symptomatically or control subjects (P < .001).

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Büyüktiryaki, Mehmet, Mehmet Yekta Oncel, Nilufer Okur, Turan Derme, and Serife Suna Oguz. "Necrotizing Enterocolitis after Octreotide Treatment in a Preterm Newborn with Idiopathic Congenital Chylothorax." APSP Journal of Case Reports 8, no. 5 (November 28, 2017): 34. http://dx.doi.org/10.21699/ajcr.v8i5.628.

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Octreotide, a somatostatin analogue, has been used for the management of patients with refractory chylothorax. Side effects related to the gastrointestinal system associated with octreotide are necrotizing enterocolitis (NEC) and focal intestinal perforation. NEC is the most common and dangerous gastrointestinal emergency in premature infants. We present the development of necrotizing enterocolitis after octreotide treatment in a preterm infant with idiopathic congenital chylothorax which settled after discontinuation of octreotide.

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De Bernardo, Giuseppe, Desiree Sordino, Carolina De Chiara, Marina Riccitelli, Francesco Esposito, Maurizio Giordano, and Antonino Tramontano. "Management of NEC: Surgical Treatment and Role of Traditional X-ray Versus Ultrasound Imaging, Experience of a Single Centre." Current Pediatric Reviews 15, no. 2 (July 22, 2019): 125–30. http://dx.doi.org/10.2174/1573396314666181102122626.

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Introduction: Necrotizing enterocolitis is the most common cause of the postnatal critical conditions and remains one of the dominant causes of newborns’ death in Neonatal Intensive Care. The morbidity and mortality associated with necrotizing enterocolitis remains largely unchanged and the incidence of necrotizing enterocolitis continues to increase. There is no general agreement regarding the surgical treatment of the necrotizing enterocolitis. Methods: In this paper, we want to evaluate the results obtained in our centre from different types of necrotizing enterocolitis’s surgical treatment and to analyse the role of traditional X-ray versus ultrasound doppler imaging in the evolutionary phases of necrotizing enterocolitis. The study was conducted in the Department of Emergency-Urgency NICU, A.O.R.N. Santobono-Pausilipon in Naples from January 2010 to December 2016. Patients were monitored by hematochemical examinations and radiological orthostatic exams every 12 hours, so that they had a surgical opportunity before intestinal perforation occurred. Ultrasonography was performed to monitor preterm infants who were hospitalized in NICU and that showed NEC symptomatology in phase I Bell staging. Results: They were recruited 75 premature infants with NEC symptomatology in phase I-III of Bell staging, who underwent surgical or medical treatment. In infants with a birth weight >1500 g (N=30), laparotomy and necrotic bowel resection has generally been our preferred approach. In 46 patients we practiced a primary anastomosis after resection of an isolated necrotic intestinal segment. In patients with multiple areas of necrosis and dubious intestinal vitality, were performed a 'second-look' scheduled after 24 to 48 hours to re-evaluate the intestine. In the initial phase of necrotizing enterocolitis, when the radiographic examination shows only a specific dilation of the loops, ultrasonography shows more and more specific signs, as wall thickening, alteration of parietal echogenicity, increase in wall perfusion, single or sporadic airborne microbubbles in the thickness of wall sections. Conclusion: Optimal surgical therapy for NEC begins with adequate antibiotic therapy, reintegration of liquids but above all with timely diagnosis, aimed to discover early prodromic phases of wall damage by US, a fundamental tool. Abdomen radiography shows specificity frameworks only when barrier damage is detected while US provides real-time imaging of abdominal structures, highlighting some elements that are completely excluded by radiograph.

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Bhatti, Karandeep S., and Arvinder Singh. "Necrotizing enterocolitis: a case report." International Journal of Contemporary Pediatrics 7, no. 5 (April 24, 2020): 1150. http://dx.doi.org/10.18203/2349-3291.ijcp20201654.

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Nectrotizing enterocilitis(NEC), a disease predominant in the premature formula fed infants, is a major cause of morbidity and mortality in NICU survivors. The symptoms may vary from apnea, fever, lethargy to abdominal distension, bloody stools, poor feeding and vomiting. The mainstay of treatment is the IV feeds, discontinuation of oral feeds, nasogastric (NG) decompression, possible breathing support and surgery. The objective of this case report is to discuss the presentation, treatment, prognosis and proposed preventative measures of NEC, which can help raise awareness and henceforth improve the management and subsequent prognosis of this disease. Authors present to you the case report of a VLBW (Very Low Birth Weight) premature infant with NEC.

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5

Pierro, Agostino, and Nigel Hall. "Surgical treatment of infants with necrotizing enterocolitis." Seminars in Neonatology 8, no. 3 (June 2003): 223–32. http://dx.doi.org/10.1016/s1084-2756(03)00025-3.

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Carter, Brigit M. "Treatment Outcomes of Necrotizing Enterocolitis for Preterm Infants." Journal of Obstetric, Gynecologic & Neonatal Nursing 36, no. 4 (July 2007): 377–85. http://dx.doi.org/10.1111/j.1552-6909.2007.00157.x.

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7

Kim, L. V., V. A. Zhelev, G. V. Slizovsky, and T. S. Liulka. "Early diagnosis of necrotizing enterocolitis." Voprosy praktičeskoj pediatrii 17, no. 2 (2022): 148–52. http://dx.doi.org/10.20953/1817-7646-2022-2-148-152.

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Necrotizing enterocolitis (NEC) is one of the most severe diseases in preterm newborns. Despite numerous studies analyzing NEC, many aspects of its etiology, pathogenesis, diagnosis, and treatment are still poorly understood. NEC diagnosis at early stages remains extremely challenging. It is early diagnosis that ensures timely treatment initiation and reduces mortality. There is a clear need for early diagnostic biomarkers of NEC, since it will improve treatment outcomes and expand our understanding of NEC pathogenesis. This literature review summarizes information on laboratory and instrumental diagnostics of NEC, which can facilitate the identification of new biomarkers. Key words: necrotizing enterocolitis, preterm infants, newborn, diagnosis

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8

Pham, Jennifer T., Allison F. Dahlgren, and Phornphat Rasamimari. "Recommendations for Diagnosis and Prevention of Cytomegalovirus-Associated Necrotizing Enterocolitis in Breast-Fed Preterm Infants." Journal of Pediatric Pharmacology and Therapeutics 27, no. 2 (February 1, 2022): 180–91. http://dx.doi.org/10.5863/1551-6776-27.2.180.

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We present the case of a breast-fed preterm infant with postnatally acquired cytomegalovirus (CMV) and severe necrotizing enterocolitis (NEC) associated with CMV. The infant had persistent severe thrombocytopenia with clinical deterioration despite multiple platelet transfusions and maximal medical treatment. Surgical intervention was not feasible owing to the instability of the infant's condition. Upon identification of CMV in urine, intravenous ganciclovir was initiated with significant clinical improvement. We also present a literature review of cases of CMV-related NEC or other gastrointestinal complications in preterm and term infants.

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9

Maltais-Bilodeau, Camille, Ewa Henckel, Kelly D. Cobey, Nadera Ahmadzai, Becky Skidmore, Emanuela Ferretti, and Bernard Thébaud. "Efficacy of mesenchymal stromal cells in preclinical models of necrotizing enterocolitis: a systematic review protocol." F1000Research 10 (October 5, 2021): 1011. http://dx.doi.org/10.12688/f1000research.73094.1.

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Introduction: Necrotizing enterocolitis is an acute inflammatory disease of the intestine that can lead to necrosis and bowel perforation. It is a severe complication of preterm birth. It’s mortality rate is up to 50% and survival after necrotizing enterocolitis leads to long-term complications. The current treatment is supportive and includes bowel rest and decompression and antibiotics. Thus, new treatments are necessary to reduce mortality and morbidity. Mesenchymal stromal cells are known to have anti-inflammatory properties and might be a promising option for treatment. Here we present a protocol for a systematic review with the aim to explore the efficacy of cell therapies with mesenchymal stromal cells in animal models of necrotizing enterocolitis. The primary outcome is histological signs of necrotizing enterocolitis. Additional outcomes include survival, bowel perforation, gut permeability, gut motility, levels of inflammatory markers, cytokine levels and adverse events. Methods: We will conduct a systematic search of MEDLINE, Embase, and Web of Science databases. The retrieved records will be screened individually by two investigators. We will include all preclinical in vivo animal models of experimentally induced necrotizing enterocolitis that evaluate the efficacy of mesenchymal stromal cells or other cell therapy treatments. Outcome data will be extracted from each article and risk of bias assessment performed. Funnel plots and SYRCLE’s risk of bias tool for animal studies will be used. Data will be reported as ratios, divided in predefined subgroups where relevant. Conclusions: This systematic review aims to examine the efficacy of mesenchymal stromal cells in preclinical models of necrotizing enterocolitis and whether there is sufficient evidence to support a clinical trial of efficacy and safety of the treatment with mesenchymal stromal cells in infants with necrotizing enterocolitis.

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10

Maltais-Bilodeau, Camille, Ewa Henckel, Kelly D. Cobey, Nadera Ahmadzai, Becky Skidmore, Emanuela Ferretti, and Bernard Thébaud. "Efficacy of mesenchymal stromal cells in preclinical models of necrotizing enterocolitis: a systematic review protocol." F1000Research 10 (October 5, 2021): 1011. http://dx.doi.org/10.12688/f1000research.73094.1.

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Introduction: Necrotizing enterocolitis is an acute inflammatory disease of the intestine that can lead to necrosis and bowel perforation. It is a severe complication of preterm birth. It’s mortality rate is up to 50% and survival after necrotizing enterocolitis leads to long-term complications. The current treatment is supportive and includes bowel rest and decompression and antibiotics. Thus, new treatments are necessary to reduce mortality and morbidity. Mesenchymal stromal cells are known to have anti-inflammatory properties and might be a promising option for treatment. Here we present a protocol for a systematic review with the aim to explore the efficacy of cell therapies with mesenchymal stromal cells in animal models of necrotizing enterocolitis. The primary outcome is histological signs of necrotizing enterocolitis. Additional outcomes include survival, bowel perforation, gut permeability, gut motility, levels of inflammatory markers, cytokine levels and adverse events. Methods: We will conduct a systematic search of MEDLINE, Embase, and Web of Science databases. The retrieved records will be screened individually by two investigators. We will include all preclinical in vivo animal models of experimentally induced necrotizing enterocolitis that evaluate the efficacy of mesenchymal stromal cells or other cell therapy treatments. Outcome data will be extracted from each article and risk of bias assessment performed. Funnel plots and SYRCLE’s risk of bias tool for animal studies will be used. Data will be reported as ratios, divided in predefined subgroups where relevant. Conclusions: This systematic review aims to examine the efficacy of mesenchymal stromal cells in preclinical models of necrotizing enterocolitis and whether there is sufficient evidence to support a clinical trial of efficacy and safety of the treatment with mesenchymal stromal cells in infants with necrotizing enterocolitis.

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Mutanen, Annika, Agostino Pierro, and Augusto Zani. "Perioperative Complications Following Surgery for Necrotizing Enterocolitis." European Journal of Pediatric Surgery 28, no. 02 (March 13, 2018): 148–51. http://dx.doi.org/10.1055/s-0038-1636943.

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AbstractNecrotizing enterocolitis (NEC) is a devastating condition that mainly affects premature infants. Advanced cases of NEC require surgical treatment, which in up to 70% of infants is associated with significant perioperative morbidity including anastomosis- or enterostomy-related complications, sepsis, peritonitis, and wound infections. Moreover, the perioperative complications may compromise the long-term gastrointestinal and neurodevelopmental outcome of patients requiring surgery for NEC.

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12

Bazacliu, Catalina, and Josef Neu. "Necrotizing Enterocolitis: Long Term Complications." Current Pediatric Reviews 15, no. 2 (July 22, 2019): 115–24. http://dx.doi.org/10.2174/1573396315666190312093119.

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Necrotizing enterocolitis (NEC) remains the most threatening gastrointestinal complication of prematurity leading to high mortality, morbidity and cost. Common complications of NEC include neurodevelopmental delay, failure to thrive, gastrointestinal problems including strictures and adhesions, cholestasis, short bowel syndrome with or without intestinal failure that can be difficult to manage. Infants who develop NEC benefit from close follow-up for early diagnosis and treatment of complications. Those who present with severe complications such as intestinal failure benefit from a multidisciplinary approach involving careful assessment and treatment. Studies done so far are limited in providing a long-term prognosis. Here we review some of these complications. More studies with a longer follow-up period are needed to better understand the later comorbidities that develop in babies with NEC.

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Fazylova, A. Sh, D. I. Akhmedova, A. T. Kamilova, and S. S. Khasanova. "Prognostic criteria for the development of necrotizing enterocolitis in deeply premature newborns." Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) 66, no. 6 (January 19, 2022): 58–62. http://dx.doi.org/10.21508/1027-4065-2021-66-6-58-62.

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In order to develop prognostic criteria for the development of necrotizing enterocolitis, the authors studied clinical and biochemical data of 108 premature infants born and nursed in the departments of the Republican Perinatal Center. The prognostic scale is based on the modification of the probabilistic Bayes method – the method of normalized intensive indicators with the calculation of prognostic, weight indices, normalized intensive and integrated indicators. Individual forecast of the development of necrotizing enterocolitis allows the development of treatment, prevention and rehabilitation measures.

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Lueschow, Shiloh R., Timothy J. Boly, Steven A. Frese, Giorgio Casaburi, Ryan D. Mitchell, Bethany M. Henrick, and Steven J. McElroy. "Bifidobacterium longum Subspecies infantis Strain EVC001 Decreases Neonatal Murine Necrotizing Enterocolitis." Nutrients 14, no. 3 (January 24, 2022): 495. http://dx.doi.org/10.3390/nu14030495.

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Necrotizing enterocolitis (NEC) is a disease mainly of preterm infants with a 30–50% mortality rate and long-term morbidities for survivors. Treatment strategies are limited and have not improved in decades, prompting research into prevention strategies, particularly with probiotics. Recent work with the probiotic B. infantis EVC001 suggests that this organism may generate a more appropriate microbiome for preterm infants who generally have inappropriate gut colonization and inflammation, both risk factors for NEC. Experimental NEC involving Paneth cell disruption in combination with bacterial dysbiosis or formula feeding was induced in P14-16 C57Bl/6 mice with or without gavaged B. infantis. Following completion of the model, serum, small intestinal tissue, the cecum, and colon were harvested to examine inflammatory cytokines, injury, and the microbiome, respectively. EVC001 treatment significantly decreased NEC in a bacterial dysbiosis dependent model, but this decrease was model-dependent. In the NEC model dependent on formula feeding, no difference in injury was observed, but trending to significant differences was observed in serum cytokines. EVC001 also improved wound closure at six and twelve hours compared to the sham control in intestinal epithelial monolayers. These findings suggest that B. infantis EVC001 can prevent experimental NEC through anti-inflammatory and epithelial barrier restoration properties.

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Gosa, Memorie M., and Mark R. Corkins. "Necrotizing Enterocolitis and the Use of Thickened Liquids for Infants With Dysphagia." Perspectives on Swallowing and Swallowing Disorders (Dysphagia) 24, no. 2 (April 2015): 44–49. http://dx.doi.org/10.1044/sasd24.2.44.

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Necrotizing enterocolotis (NEC) is a common cause of morbidity and mortality in infants that are born prematurely. The exact cause of NEC is not known. Clinical correlations between the use of thickened fluids and the development of NEC have been established. Thickened fluids are commonly used for the treatment of symptoms from both dysphagia and gastroesophageal reflux disease (GERD) in fragile infant populations. Despite its frequent recommendation, there is little empirical evidence to support the use of thickened fluids in pediatric populations for the treatment of dysphagia or GERD. There is emerging evidence to support the use of slower flowing bottle/nipple systems and side lying feeding position to support safe oral intake in infant populations. Speech-language pathologists who work in neonatal intensive care units and who work with other fragile infant populations must be aware of the risks associated with the use of thickened fluids in these populations and be prepared to provide alternative treatment options as appropriate.

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Palleri, Elena, Veronica Frimmel, Urban Fläring, Marco Bartocci, and Tomas Wester. "Hyponatremia at the onset of necrotizing enterocolitis is associated with intestinal surgery and higher mortality." European Journal of Pediatrics 181, no. 4 (December 21, 2021): 1557–65. http://dx.doi.org/10.1007/s00431-021-04339-x.

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AbstractIt has previously been shown that hyponatremia reflects the severity of inflammation in pediatric gastrointestinal diseases. Interpretation of electrolyte disorders is a common, but not well studied challenge in neonatology, especially in the context of early detection of necrotizing enterocolitis and bowel necrosis. The aim of this study was to assess if hyponatremia, or a decrease in plasma sodium level, at the onset of necrotizing enterocolitis (NEC) is associated with intestinal ischemia/necrosis requiring bowel resection and/or NEC-related deaths. This was a retrospective cohort study including patients with verified NEC (Bell’s stage ≥ 2) during the period 2009–2014. Data on plasma sodium 1–3 days before and at the onset of NEC were collected. The exposure was hyponatremia, defined as plasma sodium < 135 mmol/L and a decrease in plasma sodium. Primary outcome was severe NEC, defined as need for intestinal resection due to intestinal ischemia/necrosis and/or NEC-related death within 2 weeks of the onset of NEC. Generalized linear models were applied to analyze the primary outcome and presented as odds ratio. A total of 88 patients with verified NEC were included. Fifty-four (60%) of them had severe NEC. Hyponatremia and a decrease in plasma sodium at onset of NEC were associated with increased odds of severe NEC (OR crude 3.91, 95% CI (1.52–10.04) and 1.19, 95% CI (1.07–1.33), respectively). Also, a sub-analysis, excluding infants with pneumoperitoneum during the NEC episode, showed an increased odds ratio for severe NEC in infants with hyponatremia (OR 23.0, 95% CI (2.78–190.08)).Conclusions: The findings of hyponatremia and/or a sudden decrease in plasma sodium at the onset of NEC are associated with intestinal surgery or death within 2 weeks. What is Known:• Clinical deterioration, despite optimal medical treatment, is a relative indication for surgery in infants with necrotizing enterocolitis.• Hyponatremia is a common condition in preterm infants from the second week of life. What is New:• Hyponatremia and a decrease in plasma sodium level at the onset of necrotizing enterocolitis are positively associated with need of surgery or death within 2 weeks.• In infants with necrotizing enterocolitis, without pneumoperitoneum, where clinical deterioration despite optimal medical treatment is the only indication for surgery, hyponatremia, or a decrease in plasma sodium level can predict the severity of the disease.

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Priya, A., Mohammed Fardan, Aswathy M. Shaji, R. Kannan, and K. Arun Chander Yadav. "Clinical management and outcome of extreme preterm infant with respiratory distress syndrome, early onset sepsis and necrotizing enterocolitis stage 1: a case report." International Journal of Basic & Clinical Pharmacology 10, no. 5 (April 26, 2021): 580. http://dx.doi.org/10.18203/2319-2003.ijbcp20211658.

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Respiratory distress syndrome, although it is common in extreme preterm infants, early and effective management will aid in better outcome. Preterm also comes with multiple co- morbidities which has to be considered and stepwise treatment is utmost important in tackling them. Here, we report a case of an extreme preterm baby who experienced respiratory distress syndrome with early onset sepsis along with necrotizing enterocolitis. Early diagnosis and management helped in the discharge of the infant in stable condition.

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Moschopoulos, Chariton, Panagiotis Kratimenos, Ioannis Koutroulis, Bhairav V. Shah, Anja Mowes, and Vineet Bhandari. "The Neurodevelopmental Perspective of Surgical Necrotizing Enterocolitis: The Role of the Gut-Brain Axis." Mediators of Inflammation 2018 (2018): 1–8. http://dx.doi.org/10.1155/2018/7456857.

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This state-of-the-art review article aims to highlight the most recent evidence about the therapeutic options of surgical necrotizing enterocolitis, focusing on the molecular basis of the gut-brain axis in relevance to the neurodevelopmental outcomes of primary peritoneal drainage and primary laparotomy. Current evidence favors primary laparotomy over primary peritoneal drainage as regards neurodevelopment in the surgical treatment of necrotizing enterocolitis. The added exposure to inhalational anesthesia in infants undergoing primary laparotomy is an additional confounding variable but requires further study. The concept of the gut-brain axis suggests that bowel injury initiates systemic inflammation potentially affecting the developing central nervous system. Signals about microbes in the gut are transduced to the brain and the limbic system via the enteric nervous system, autonomic nervous system, and hypothalamic-pituitary axis. Preterm infants with necrotizing enterocolitis have significant differences in the diversity of the microbiome compared with preterm controls. The gut bacterial flora changes remarkably prior to the onset of necrotizing enterocolitis with a predominance of pathogenic organisms. The type of initial surgical approach correlates with the length of functional gut and microbiome equilibrium influencing brain development and function through the gut-brain axis. Existing data favor patients who were treated with primary laparotomy over those who underwent primary peritoneal drainage in terms of neurodevelopmental outcomes. We propose that this is due to the sustained injurious effect of the remaining diseased and necrotic bowel on the developing newborn brain, in patients treated with primary peritoneal drainage, through the gut-brain axis and probably not due to the procedure itself.

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Smirnov, Ivan E., T. N. Shishkina, A. G. Kucherenko, and Yu I. Kucherov. "Cytokines and matrix metalloproteinases in premature infants with necrotizing enterocolitis." Russian Pediatric Journal 19, no. 6 (April 30, 2019): 343–50. http://dx.doi.org/10.18821/1560-9561-2016-19-6-343-350.

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Necrotizing enterocolitis (NEC) is a major cause of the morbidity and high mortality in preterm infants. With the ELISA method there were determined cytokine concentrations of the transforming growth factor-β (TGF-β), macrophage inflammatory protein1β (MIP-1β), matrix metalloproteinases (MMP-2, -3, -8, -9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in low birthweight (LBW) premature infants with NEC. There were examined 68 infants at the conservative and surgical stages of NEC. In all patients on admission at 3rd and 7th day of the treatment the concentration of these compounds was determined in blood serum and tissues from damaged ileum and colon. There were established divergent differences in TGF-β content (reduction by 1,9-3 times) and MIP-1β (1.3-1.5 fold increase) in serum as compared with the control. More pronounced changes in the blood concentrations of these biomarkers in patients at the surgical stage of the NEC due to a decrease in TGF-β content, a significant increase in MIP-1β concentrations, MMP-8, TIMP-1 and the lack of the decrease in their content in the course of treatment, are associated with the severe course of NEC in LBW premature infants and prove to be indices of the unfavorable course of NEC, which requires to revise and optimize the therapeutic approach timely in such patients.

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Ou, Jocelyn, Cathleen M. Courtney, Allie E. Steinberger, Maria E. Tecos, and Brad W. Warner. "Nutrition in Necrotizing Enterocolitis and Following Intestinal Resection." Nutrients 12, no. 2 (February 18, 2020): 520. http://dx.doi.org/10.3390/nu12020520.

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This review aims to discuss the role of nutrition and feeding practices in necrotizing enterocolitis (NEC), NEC prevention, and its complications, including surgical treatment. A thorough PubMed search was performed with a focus on meta-analyses and randomized controlled trials when available. There are several variables in nutrition and the feeding of preterm infants with the intention of preventing necrotizing enterocolitis (NEC). Starting feeds later rather than earlier, advancing feeds slowly and continuous feeds have not been shown to prevent NEC and breast milk remains the only effective prevention strategy. The lack of medical treatment options for NEC often leads to disease progression requiring surgical resection. Following resection, intestinal adaptation occurs, during which villi lengthen and crypts deepen to increase the functional capacity of remaining bowel. The effect of macronutrients on intestinal adaptation has been extensively studied in animal models. Clinically, the length and portion of intestine that is resected may lead to patients requiring parenteral nutrition, which is also reviewed here. There remain significant gaps in knowledge surrounding many of the nutritional aspects of NEC and more research is needed to determine optimal feeding approaches to prevent NEC, particularly in infants younger than 28 weeks and <1000 grams. Additional research is also needed to identify biomarkers reflecting intestinal recovery following NEC diagnosis individualize when feedings should be safely resumed for each patient.

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Wang, Bingjie, and Meghan A. Koch. "Cytokine therapy in necrotizing enterocolitis: A promising treatment for preterm infants." Cell Reports Medicine 2, no. 6 (June 2021): 100324. http://dx.doi.org/10.1016/j.xcrm.2021.100324.

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Kozlov, Y. A., V. A. Novozhilov, K. A. Kovalkov, D. M. Chubko, A. A. Rasputin, I. N. Weber, P. Z. Baradieva, et al. "SURGICAL TREATMENT OF NECROTIZING ENTEROCOLITIS IN PREMATURE INFANTS – MULTILEVEL COMPARISON RESULTS." Pediatria. Journal named after G.N. Speransky 97, no. 1 (February 12, 2018): 88–95. http://dx.doi.org/10.24110/0031-403x-2018-97-1-88-95.

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23

Yuzbasheva, Elnara, and Irada Garadaghi. "PP-289. Necrotizing enterocolitis in preterm infants, preventive and treatment strategies." Early Human Development 86 (November 2010): S131—S132. http://dx.doi.org/10.1016/j.earlhumdev.2010.09.345.

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Moore, Amy B., and Don K. Nakayama. "Preformed Silastic Silos in the Management of Necrotizing Enterocolitis." American Surgeon 75, no. 2 (February 2009): 172–74. http://dx.doi.org/10.1177/000313480907500212.

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Necrotizing enterocolitis (NEC) is sometimes complicated by abdominal compartment syndrome, a clinical syndrome characterized by multiple organ dysfunction that arises as a consequence of increased intra-abdominal pressure. The evolving clinical picture of NEC sometimes requires “second-look” operations done after initial abdominal exploration to more accurately gauge the optimal extent of surgery. Placing intestines in a preformed, spring-loaded, transparent Silastic silo, traditionally used in the staged treatment of gastroschisis, addresses both situations: decompression of the abdomen and allowing periodic inspection of the intestines. Standard silos were used in three infants with advanced (Bell Class 3) NEC without perforation before definitive surgery. Clinical indices and laboratory values were recorded during the patients’ hospital courses. All three infants had extensive areas of intestinal ischemia and necrosis. FiO2, acidosis, and urinary output remained stable or improved in two patients. Silo placement corrected abdominal compartment syndrome in the third patient. Intestinal resection was required in all infants, each achieving surgical resolution of NEC. Two patients ultimately died from respiratory and neurologic complications. Application of a silo addresses abdominal compartment syndrome as a complication of NEC and allows continual inspection of the intestines. Physiological indices may improve the patient's overall clinical status.

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MOZGIEL, JAROSŁAW. "Early and late results of the treatment of necrotizing enterocolitis in newborns and infants." PRZEGLĄD CHIRURGII DZIECIĘCEJ 1, no. 2 (February 2, 2007): 167–74. http://dx.doi.org/10.1066/s10023060020.

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26

Liu, Donald, and Jeffrey Matthews. "Is there an optimal surgical treatment for infants with perforated necrotizing enterocolitis?" Nature Clinical Practice Gastroenterology & Hepatology 4, no. 1 (January 2007): 18–19. http://dx.doi.org/10.1038/ncpgasthep0689.

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Harms, K., S. Michalski, Ch P. Speer, FE Lüdtke, and G. Lepsien. "Interdisciplinary treatment of necrotizing enterocolitis and spontaneous intestinal perforations in preterm infants." Acta Paediatrica 83, s396 (April 1994): 53–57. http://dx.doi.org/10.1111/j.1651-2227.1994.tb13244.x.

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Luh Made Diah Wulandari Artana, I Made Kardana, I Wayan Dharma Artana, Putu Junara Putra, Made Sukmawati, and Putu Mas Vina Paramita Cempaka. "Risk factors of thrombocytopenia in term infants in Prof. Dr. I.G.N.G. Hospital Denpasar Bali." GSC Advanced Research and Reviews 13, no. 2 (November 30, 2022): 215–20. http://dx.doi.org/10.30574/gscarr.2022.13.2.0322.

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Thrombocytopenia is a condition in which platelet count below 150 x 109/L. Neonatal thrombocytopenia (NT) accounts up to 35% of all patients admitted to neonatal intensive care unit (NICU). The underlying cause of NT can often be predicted by the onset time of thrombocytopenia and course of disease. The purpose of this study was to determine the risk factors of thrombocytopenia in term infants undergoing treatment at Prof. Dr. I.G.N.G. Hospital. Method: An observational analytical study using case-control design was conducted in 50 term infants from March 2021 to October 2021 in Prof. Dr. I.G.N.G. Hospital Denpasar Bali. Result: Total 25 infants with thrombocytopenia in case group and 25 infants without thrombocytopenia in control group. Most of the infants were dominated by female gender (54%), mean gestational age was 38 (± 1) weeks, birth weight 2,940 (± 445) gram, cesarean section (56%). In addition, 48% of patients were vigorous babies. Early-onset neonatal sepsis (EOS) was 76% and late-onset neonatal sepsis (LOS) was 14%, most infants had neonatal pneumonia 58% and necrotizing enterocolitis (NEC) 48%. Mothers with preeclampsia were 26%. Multivariate analysis showed EOS was risk factor for NT (OR 4.69; 95% CI 0.9 – 22.0) and NEC (OR 4.17; 95% CI 1.2 – 14.4). Conclusion: Early onset neonatal sepsis (EOS) and necrotizing enterocolitis (NEC) are risk factors for thrombocytopenia in term infants.

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Kozlov, Yu A., M. N. Mochalov, K. A. Kovalkov, S. S. Poloyan, P. Zh Baradieva, D. A. Zvonkov, Ch B. Ochirov, et al. "Multiple intestinal anastomosis in newborns and infants." Russian Journal of Pediatric Surgery 25, no. 3 (July 20, 2021): 153–57. http://dx.doi.org/10.18821/1560-9510-2021-25-3-153-157.

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Introduction. The present trial systematizes data, taken from one surgical center as an example, on treating patients with intestinal atresia and necrotizing enterocolitis with multiple intestinal anastomoses.Material and methods. The trial is a retrospective review on the treatment of 13 newborn infants who since 2010 have been put multiple intestinal anastomoses; the treatment was approved by the Hospital Ethics Committee. The average gestational age of patients was 31.2 weeks. The average age at the time of surgery – 7,9 days. Average weight - 2007 grams. The average number of anastomoses was 3.7 (range: 2-7). The average length of remained small intestine after the second surgery was 67.4 cm (range: 12-120 cm). No other surgical procedures, including gastrostomy or enterostomy, were performed. In all cases, surgical intervention ended with hermetic suturing of the abdominal cavity. Among them, there were 6 patients with the multifocal form of necrotizing enterocolitis; 6 patients had type IV atresia of the small intestine; 1 patient had the Ladd’s syndrome. Connection of intestinal segments was made by constructing several “end-to-end” anastomoses, double-row precision seam with PDS II 7/0 suture.Results. In the postoperative period, complications associated with anastomosis construction, such as leakage and narrowing, were not recorded. Transit function of the gastrointestinal tract restored on day 4, on average, after the surgery (range: 2-6 days). There were no early lethal outcomes within the first 28 days after the surgery which were associated with the surgery. 2 patients with short bowel syndrome (remained small intestine was 12 and 25 cm) and multivisceral disorders died on day 72 and 64 after the surgery. Survived patients were transferred to full enteral feeding in 56 days, in average, after the second surgery (range - 15-120 days).Conclusion. In our study, we have demonstrated potentials of a new surgical approach: one-stage formation of multiple intestinal anastomoses in case of multiple intestinal atresias as well as in case of multifocal forms of necrotizing enterocolitis. Maintaining the bowel length with multiple bowel anastomoses is very important factor for better survival of patients with the short bowel syndrome.

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Shishkina, Tatyana N., I. E. Smirnov, A. G. Kucherenko, Yu I. Kucherov, and M. G. Rekhviashvili. "Serum calprotectin, C-reactive protein and procalcitonin in preterm infants with necrotizing enterocolitis." Russian Pediatric Journal 19, no. 4 (April 30, 2019): 217–22. http://dx.doi.org/10.18821/1560-9561-2016-19-4-217-222.

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Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in preterm infants. The development of NEC is associated with changes in the expression of a number of acute phase proteins and cytokines, such as C-reactive protein (CRP), procalcitonin (PCT), calprotectin (CP). To determine their diagnostic and prognostic significance there were performed studies of the dynamics of the blood levels of CRP, PCT and CP in preterm infants with NEC. A total of 68 premature infants with conservative and surgical stages of the NEC were examined. In all patients at admission, 3rd and 7th day of the treatment there was determined the serum concentration of CRP, PCT and CP. The gradual significant decline in CRP, PCT and CP. Blood concentrations was established at the 7th day of the observation ofpatients with conservative stage of NEC, which was associated with a favorable outcome of the treatment of NEC in this group of preterm infants. More pronounced changes in these markers in the blood of patients with surgical stage of the SEC due to a sharp increase in concentration and a lack of the decline in their content in the course of treatment, are associated with severe NEC and are a formidable sign of unfavorable course of the NEC, which requires timely revision and optimization of the treatment of such patients.

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Kaplina, Aleksandra, Svetlana Kononova, Ekaterina Zaikova, Tatiana Pervunina, Natalia Petrova, and Stanislav Sitkin. "Necrotizing Enterocolitis: The Role of Hypoxia, Gut Microbiome, and Microbial Metabolites." International Journal of Molecular Sciences 24, no. 3 (January 27, 2023): 2471. http://dx.doi.org/10.3390/ijms24032471.

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Necrotizing enterocolitis (NEC) is a life-threatening disease that predominantly affects very low birth weight preterm infants. Development of NEC in preterm infants is accompanied by high mortality. Surgical treatment of NEC can be complicated by short bowel syndrome, intestinal failure, parenteral nutrition-associated liver disease, and neurodevelopmental delay. Issues surrounding pathogenesis, prevention, and treatment of NEC remain unclear. This review summarizes data on prenatal risk factors for NEC, the role of pre-eclampsia, and intrauterine growth retardation in the pathogenesis of NEC. The role of hypoxia in NEC is discussed. Recent data on the role of the intestinal microbiome in the development of NEC, and features of the metabolome that can serve as potential biomarkers, are presented. The Pseudomonadota phylum is known to be associated with NEC in preterm neonates, and the role of other bacteria and their metabolites in NEC pathogenesis is also discussed. The most promising approaches for preventing and treating NEC are summarized.

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Kozlov, Y. A., V. A. Novozhilov, I. N. Weber, A. A. Rasputin, K. A. Kovalkov, D. M. Chubko, P. Z. Baradieva, et al. "SURGICAL TREATMENT OF NECROTIZING ENTEROCOLITIS MULTIFOCAL FORMSIN PREMATURE INFANTS – CLIP AND DROP TECHNIQUE." Pediatria. Journal named after G.N. Speransky 96, no. 4 (August 10, 2017): 116–20. http://dx.doi.org/10.24110/0031-403x-2017-96-4-116-120.

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Korya, D., K. S. Bergman, M. C. Meadows, and R. S. Chamberlain. "Necrotizing Enterocolitis in Preterm Infants: Utilizing Damage Control Laparotomy Principles in Surgical Treatment." Journal of Surgical Research 158, no. 2 (February 2010): 276–77. http://dx.doi.org/10.1016/j.jss.2009.11.298.

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Lam, Hugh Simon, Hon Ming Cheung, Terence Chuen Wai Poon, Raymond Pui On Wong, Kam Tong Leung, Karen Li, and Pak Cheung Ng. "Neutrophil CD64 for Daily Surveillance of Systemic Infection and Necrotizing Enterocolitis in Preterm Infants." Clinical Chemistry 59, no. 12 (December 1, 2013): 1753–60. http://dx.doi.org/10.1373/clinchem.2013.209536.

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BACKGROUND Early detection and treatment of infected preterm infants could decrease morbidity and mortality. Neutrophil CD64 has been shown to be an excellent early diagnostic biomarker of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC). We aimed to study whether using CD64 as a daily surveillance biomarker could predict LOS/NEC before clinical manifestation. METHODS We collected 0.1 mL whole blood from very low birth weight (VLBW) infants from day 7 postnatal age until routine daily blood tests were no longer required. Four categories of responses were defined: proven sepsis, clinical sepsis, nonsepsis/non-NEC, and asymptomatic CD64 activation. RESULTS A total of 146 infants were consecutively recruited and 155 episodes of sepsis evaluation were performed. The biomarker screening utility, sensitivity, specificity, positive predictive value, and negative predictive value for surveillance of LOS/NEC using a cutoff of 5655 antibody-PE (phycoerythrin) molecules bound/cell were 89%, 98%, 41%, and 99.8%, respectively. LOS/NEC was detected a mean of 1.5 days before clinical presentation. However, 63 episodes of CD64 activation occurred in asymptomatic infants who would not otherwise have required sepsis evaluations. CONCLUSIONS As a surveillance biomarker, neutrophil CD64 detected LOS/NEC 1.5 days before clinical presentation, but at the expense of performing 41% additional sepsis evaluations. This was mainly attributed to an unexpected group of asymptomatic infants with CD64 activation, who recovered spontaneously and did not require antimicrobial treatment. The latter group has not been previously recognized in VLBW infants and could represent subclinical infection secondary to transient bacterial translocation or mild viral infection.

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Anderson, Sharon. "Probiotics for Preterm Infants: A Premature or Overdue Necrotizing Enterocolitis Prevention Strategy?" Neonatal Network 34, no. 2 (2015): 83–101. http://dx.doi.org/10.1891/0730-0832.34.2.83.

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AbstractCommon among preterm, very low birth weight (VLBW) and extremely low birth weight (ELBW) infants, necrotizing enterocolitis (NEC) is a gastrointestinal, infectious disease that remains a leading cause of morbidity and mortality among this high-risk population. To combat this devastating condition, research efforts have been redirected from treatment toward prevention strategies. Although there are several proposed risk-reduction strategies, one intervention gaining support is the administration of prophylactic enteral probiotics. Regardless of growing evidentiary support and a benign safety profile, neonatal providers have yet to embrace this therapy. This article provides an overview of the proposed benefits of probiotics, focusing on their role as a NEC prevention strategy. A review of several sentinel research studies targeting preterm, VLBW, and ELBW infants is provided. Considerations for ongoing research are reviewed. Finally, two evidence-based NEC prevention probiotics protocols are presented.

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Ehrlich, Peter F., Tom T. Sato, Billie L. Short, and Gary E. Hartman. "Outcome of Perforated Necrotizing Enterocolitis in the Very Low-Birth Weight Neonate May be Independent of the Type of Surgical Treatment." American Surgeon 67, no. 8 (August 2001): 752–56. http://dx.doi.org/10.1177/000313480106700807.

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Perforated necrotizing enterocolitis (NEC) in the low-birth weight infant is now one of the most common surgical problems encountered in contemporary neonatal intensive care units. However, morbidity and mortality from NEC remain high, and the optimal surgical management of these infants remains controversial. Currently few data exist comparing the factors influencing outcome in very low-birth weight infants with perforated NEC treated by either local drainage or exploration. We hypothesize that survival of very low-birth weight neonates with perforated NEC may be more dependent on clinical status than on treatment modality. We present our experience treating a large cohort of infants weighing less than 1000 g with perforated NEC. A retrospective cohort study describes our experience with perforated NEC in very low-birth weight infants in a Level III neonatal intensive care unit. Between January 1991 and May 1998 a total of 70 newborn infants weighing less than 1000 g were evaluated and managed for perforated NEC. Comorbid factors were identified and calculated for each infant. Primary treatment was either local drainage or laparotomy. Statistical analysis was performed by Student's t test and multiple logistic regression. A multiple logistic regression model examined factors (comorbidities, number of comorbidities, and mode intervention) influencing outcome. A Kaplan-Meier survival analysis comparing survival versus number of comorbidities was performed. Twenty-two infants with an average weight of 679 g were treated by local drainage. Forty-eight infants with an average weight of 756 g were treated with exploratory laparotomy. Infants treated by local drainage had a higher cumulative number of comorbid factors (5.2 ± 0.50 vs 3.7 ± 0.29; P < 0.05) than those managed by operative exploration. Fourteen infants (63%) initially undergoing local drainage for perforated NEC survived. Of the 48 infants 36 operated on survived (75%). No single factor or combination of any comorbid factors was predictive of outcome. The total number of comorbidities for each neonate did reach statistical significance ( P < 0.05). A greater likelihood of death was associated with a higher number of comorbidities. Survival with four or fewer comorbidities was 84 per cent, whereas survival with greater than six comorbidities was 30 per cent. The mean number of comorbidities was greater for drainage than for surgery, and for the same number of comorbidities the probability of survival tended to be greater for those treated with drainage than for those undergoing surgery. Multiple logistic regression analysis identified the total number of comorbidities as affecting outcome rather than treatment choice. This suggests therefore that selection of therapeutic options for the patient requires evaluating all factors that may impact survival rather than applying a single treatment strategy for all patients.

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Vandenplas, Yvan, and Koen Huysentruyt. "Probiotic interventions to optimize the infant and child microbiota." World Nutrition Journal 1, no. 2 (January 31, 2018): 23. http://dx.doi.org/10.25220/wnj.v01i2.0005.

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The optimal healthy microbiota during early life still needs further evaluation. Pre- and probiotics are commonly used as supplementation in infant formula.Prebiotic oligosaccharides stimulate the growth of bifidobacteria aiming to mimic the gastrointestinal microbiota of breastfed infants. In general, results with prebiotics in therapeutic indications are disappointing.Studies suggest that probiotic supplementation may be beneficial in prevention and management of disease such as e.g., reducing the risk of necrotizing enterocolitis in preterm infants, prevention and treatment of acute gastroenteritis in infants, etc. Although many studies show promising beneficial effects, the long-term health benefits and eventual risks of probiotic supplementation during early life are not clear.It is likely that ongoing research will result in the use of specific probiotic organisms and/or prebiotic oligosaccharides during the first 1,000 days of life, with the goal to develop a healthy microbiota from conception over birth into the first two years of life with a lowered risk of infections and inflammatory events.

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Livingston, M. H., T. Elliott, C. Williams, S. A. Jones, P. L. Rosenbaum, and J. M. Walton. "Glycerin suppositories used prophylactically in premature infants (supp): A pilot randomized controlled trial." Journal of Neonatal-Perinatal Medicine 13, no. 4 (November 27, 2020): 495–505. http://dx.doi.org/10.3233/npm-190310.

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BACKGROUND: Glycerin suppositories are often used to facilitate meconium evacuation in premature infants. The evidence for this practice is inconclusive. The purpose of this study was to assess the feasibility of a multicenter randomized controlled trial on the effectiveness of this treatment strategy. STUDY DESIGN: We conducted an external pilot study for a multicenter randomized controlled trial of premature infants randomized to glycerin suppositories or placebo procedure. Participants were included if they were gestational age of 24 weeks 0 days to 31 weeks 6 days and/or birthweight of 500 to 1500 grams. We excluded infants with life-threatening congenital anomalies, contraindications to receiving suppositories, or signs of clinical instability. Outcomes included cost, recruitment, and treatment-related adverse events. RESULT: A total of 109 were screened, 79 were initially eligible, and 34 consented to participate. Four of these infants were excluded prior to randomization due to thrombocytopenia, 30 were randomized, and 26 reached full enteral feeds. Three infants (10%) experienced rectal bleeding 5 to 43 days after completing study treatments. An anal fissure was noted in two of these patients. There were no cases of rectal perforation but one infant assigned to active treatment developed necrotizing enterocolitis. CONCLUSIONS: Conducting a multicenter randomized controlled trial on the use of glycerin suppositories in premature infants is feasible. Minor modifications to the study protocol are needed to increase participant recruitment and simplify the administration of study treatments.

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Davis, Jonathan M., Soraya Abbasi, Lois Johnson, Mary Grous, and Chari Otis. "1373 THEOPHYLLINE TREATMENT DOES NOT INCREASE THE RISK OF NECROTIZING ENTEROCOLITIS IN PRETERM INFANTS." Pediatric Research 19, no. 4 (April 1985): 339A. http://dx.doi.org/10.1203/00006450-198504000-01397.

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Benini, Franca, F. F. Rubaltelli, P. Griffith, and F. Cantarutti. "NEONATAL NECROTIZING ENTEROCOLITIS (NEC): PREVENTION AND TREATMENT IN LBW INFANTS BY 0RAL IgG ADMINISTRATION." Pediatric Research 26, no. 5 (November 1989): 520. http://dx.doi.org/10.1203/00006450-198911000-00125.

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Song, Juan, Huimin Dong, Falin Xu, Yong Wang, Wendong Li, Zhenzhen Jue, Lele Wei, Yuyang Yue, and Changlian Zhu. "The association of severe anemia, red blood cell transfusion and necrotizing enterocolitis in neonates." PLOS ONE 16, no. 7 (July 20, 2021): e0254810. http://dx.doi.org/10.1371/journal.pone.0254810.

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Background The relationship between severe anemia, red blood cell transfusion and Neonatal necrotizing enterocolitis (NEC) remains controversial. The purpose of this study was to determine the association of severe anemia and RBC transfusion with NEC in neonates. Methods The clinical characteristics of NEC were observed in 467 infants with different birth weights from January 2012 to July 2020. A 1:1 ratio case-control study was performed in very low birth weight (VLBW) infants. Severe anemia, RBC transfusion, and confounding factors, including maternal and perinatal complications, feeding, and antibiotics administration were collected in both groups. Univariate and multivariate analyses were used to investigate effects on the risk of NEC. Results The day of NEC onset and mortality were inversely associated with birth weight. In VLBW infants, adjusting for other factors, severe anemia within 72 h [OR = 2.404, P = 0.016], RBC transfusion within 24 h [OR = 4.905, P = 0.016], within 48 h [OR = 5.587, P = 0.008], and within 72 h [OR = 2.858, P = 0.011] increased the risk of NEC. Conclusion Both severe anemia and RBC transfusion appears to increase the risk of NEC in VLBW infants. The early prevention and treatment of anemia, strict evaluation of the indications for transfusion and enhanced monitoring after transfusion is encouraged in the NICU.

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Zvizdic, Zlatan, Emir Milisic, Asmir Jonuzi, Sabina Terzic, Denisa Zvizdic, and Semir Vranic. "The Effects of Ranitidine Treatment on the Risk of Necrotizing Enterocolitis in Preterm Infants: A Case-Control Study." Acta Medica (Hradec Kralove, Czech Republic) 64, no. 1 (2021): 8–14. http://dx.doi.org/10.14712/18059694.2021.2.

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Introduction: Gastric acidity plays an important role in the protection of infants against various pathogens from the environment. The histamine-2 receptor blockers (H2-blockers) are off-labeled drugs that are frequently prescribed in preterm neonates to prevent stress ulcers. The impact of the H2-blockers on the development of the necrotizing enterocolitis (NEC) in preterm infants is still controversial, particularly in the developing world. Materials and Methods: One hundred twenty-two preterm infants were enrolled in the study. The multivariate logistic regression model was used to identify potential postnatal risk factors associated with NEC. Results: Preterm infants (n = 51) with total NEC, medical NEC, and surgical NEC had the highest rate of receiving ranitidine compared with controls (n = 71) (39.2%, 19.6%, and 47.6%, p < 0.05). Logistic regression analysis revealed that ranitidine use and nosocomial infections were significantly associated with NEC development (odds ratios 1.55 and 3.3). Conclusions: We confirm that ranitidine administration was associated with an increased risk of NEC in preterm infants. H2-blockers use should be only administered in very strictly selected cases after careful consideration of the risk-benefit ratio.

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Houben, Christoph Heinrich, Kin Wai Chan, Wai Cheung Mou, Yuk Him Tam, and Kim Hung Lee. "Management of Intestinal Strictures Post Conservative Treatment of Necrotizing Enterocolitis: The Long Term Outcome." Journal of Neonatal Surgery 5, no. 3 (July 1, 2016): 28. http://dx.doi.org/10.21699/jns.v5i3.379.

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Objectives: Evaluating the long-term outcome of the surgical management for intestinal strictures developing after necrotizing enterocolitis (NEC).Patients and methods: This is a retrospective study of all patients with an intestinal stricture after completion of conservative management for NEC. They were treated during the eight years period from 1st January 2008 to 31st December 2015.Results: During the study period 67 infants had an operation for NEC, of which 55 had emergency surgery. The remaining twelve infants (6 males) had a stricture and were included in the study group. Their median gestational age was 35 (range 27-40) weeks and the median weight was 2180 (range 770 - 3290) g. The onset of NEC was seen at a median of 2 (range 1- 47) days. The median peak C-reactive protein (CRP) level was 73.1 (range 25.2 – 232) mg/dl. Isolated strictures were seen in 9 (75%) patients. Two-third of all strictures (n=15) were located in the colon. Surgery was done at a median of 5 (range 3 - 13) weeks after diagnosing NEC. Primary anastomosis was the procedure of choice; only one needed a temporary colostomy. This cohort had no mortality during a median follow up of 6.25 (range 0.5 - 7.6) years, whilst the overall death rate for NEC was 15 (22 %). Two fifth of the group developed a neurological / sensory impairment.Conclusion: One fifth of the surgical workload for NEC is related to post-NEC strictures. Most strictures are located in the colonic region. In the long-term no mortality and no surgical co-morbidities were observed.

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Abdullah, Fizan, Yiyi Zhang, Melissa Camp, Debraj Mukherjee, Alodia Gabre-Kidan, Paul M. Colombani, and David C. Chang. "Necrotizing Enterocolitis in 20 822 Infants: Analysis of Medical and Surgical Treatments." Clinical Pediatrics 49, no. 2 (January 14, 2010): 166–71. http://dx.doi.org/10.1177/0009922809349161.

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Clark, Jessica A., Sarah M. Doelle, Melissa D. Halpern, Tara A. Saunders, Hana Holubec, Katerina Dvorak, Scott A. Boitano, and Bohuslav Dvorak. "Intestinal barrier failure during experimental necrotizing enterocolitis: protective effect of EGF treatment." American Journal of Physiology-Gastrointestinal and Liver Physiology 291, no. 5 (November 2006): G938—G949. http://dx.doi.org/10.1152/ajpgi.00090.2006.

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Necrotizing enterocolitis (NEC) is the most common intestinal disease of premature infants. Although increased mucosal permeability and altered epithelial structure have been associated with many intestinal disorders, the role of intestinal barrier function in NEC pathogenesis is currently unknown. We investigated the structural and functional changes of the intestinal barrier in a rat model of NEC. In addition, the effect of EGF treatment on intestinal barrier function was evaluated. Premature rats were divided into three groups: dam fed (DF), formula fed (NEC), or fed with formula supplemented with 500 ng/ml EGF (NEC + EGF); all groups were exposed to asphyxia/cold stress to develop NEC. Intestinal permeability, goblet cell density, mucin production, and composition of tight junction (TJ) proteins were evaluated in the terminal ileum, the site of NEC injury, and compared with the proximal jejunum, which was unaffected by NEC. Animals with NEC had significantly increased intestinal paracellular permeability compared with DF pups. Ileal goblet cell morphology, mucin production, and TJ composition were altered in animals with NEC. EGF treatment significantly decreased intestinal paracellular permeability, increased goblet cell density and mucin production, and normalized expression of two major TJ proteins, occludin and claudin-3, in the ileum. In conclusion, experimental NEC is associated with disruption of the intestinal barrier. EGF treatment maintains intestinal integrity at the site of injury by accelerating goblet cell maturation and mucin production and normalizing expression of TJ proteins, leading to improved intestinal barrier function.

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Yan, Yunying, Guixiang Zeng, and Shuwen Huang. "Systematic Evaluation of Early Inhalation of Nitric Oxide for Prevention and Treatment of Bronchopulmonary Dysplasia in Premature Infants." Tobacco Regulatory Science 7, no. 5 (September 30, 2021): 4349–57. http://dx.doi.org/10.18001/trs.7.5.1.213.

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Bronchopulmonary dysplasia (BPD) is a common chronic lung disease in premature infants, which seriously affects the quality of life of premature infants and may even lead to death of premature infants. At present, there is no unified opinion on the prevention and treatment of BPD, and the mechanism of its occurrence and development is not completely clear in clinical practice. Therefore, finding a better way to prevent and treat BPD is one of the hot spots in clinical practice. The safety of nitric oxide in premature infants with BPD is a focus of clinical attention, but its systematic evaluation has not been reported. In this study, meta-analysis method was used to analysis. The results demonstrated that there were no obvious differences in the incidence, survival, BPD-free survival, and mortality between the inhaled nitric oxide group (iNO group) and the placebo group. The common complications such as toxemia, necrotizing enterocolitis, and visual impairment between the iNO group and the placebo group were not obvious. This suggests that the use of NO to prevent BPD in premature infants has no obvious effect.

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Schurr, Patti, and Esther Perkins. "The Relationship Between Feeding and Necrotizing Enterocolitis in Very Low Birth Weight Infants." Neonatal Network 27, no. 6 (November 2008): 397–407. http://dx.doi.org/10.1891/0730-0832.27.6.397.

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Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the NICU, with often devastating consequences. The etiology of NEC is probably multifactorial, with preterm infants at the highest risk. The relationship between feeding and NEC was identified in the 1970s, leading to delayed feeding becoming standard treatment in NICUs. More recent research suggests that early feedings not only are safe, but reduce other morbidities associated with prematurity. Standardized feeding guidelines seem to confer some benefits in decreasing NEC, despite a wide variability in feeding practices within the published guidelines. A standardized approach to the management of feeding problems may be the key. This article briefly reviews the pathogenesis of NEC and examines studies of various feeding practices for their relationship to the development of NEC. It also highlights the potential benefits of breast milk in NEC prevention.

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Raghuveer, Talkad S., Richa Lakhotia, Barry T. Bloom, Debbi A. Desilet-Dobbs, and Adam M. Zarchan. "Abdominal Ultrasound and Abdominal Radiograph to Diagnose Necrotizing Enterocolitis in Extremely Preterm Infants." Kansas Journal of Medicine 12, no. 1 (February 1, 2019): 24–27. http://dx.doi.org/10.17161/kjm.v12i1.11707.

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Necrotizing enterocolitis (NEC) is an important contributor towardmortality in extremely premature infants and Very Low Birth Weight(VLBW) infants. The incidence of NEC was 9% in VLBW infants(birth weight 401 to 1,500 grams) in the Vermont Oxford Network(VON, 2006 to 2010, n = 188,703).1 The incidence of NEC was 7%in 1993, increased to 13% in 2008, and decreased to 9% in extremelypreterm infants (22 to 28 weeks gestation) in the Neonatal ResearchNetwork Centers (1993 to 2012).2 The incidence of surgically treatedNEC varies from 28 to 50% in all infants who develop NEC.3 SurgicalNEC occurred in 52% in the VON cohort.1 In this cohort, the odds ofsurgery decreased by 5% for each 100 gram increase in birth.The incidence of surgical NEC has not decreased in the pastdecade.4 The mortality from NEC is significantly higher in infantswho need surgery compared to those who did not (35% versus 21%).1The case fatality rate among patients with NEC is higher in thosesurgically treated (23 to 36%) compared to those medically treated (5to 24%).3 In addition to surgery, NEC mortality rates are influencedby gestational age, birth weight,1,2,5 assisted ventilation on the day ofdiagnosis of NEC, treatment with vasopressors at diagnosis of NEC,and black race.6,7Extremely preterm infants who survive NEC are at risk for severeneurodevelopmental disability and those with surgical NEC have asignificantly higher risk of such delays (38% surgical NEC versus 24%medical NEC).8 Diagnosis of necrotizing enterocolitis is challengingand it is usually suspected based on non-specific clinical signs. Bell’scriteria and Vermont-Oxford Network criteria help in the diagnosisof NEC.Bell’s criteria, commonly used for diagnosis, staging, and planningtreatment of NEC, were described in 1978 and modified in 1986.9,10Bell’s stage I signs are non-specific: temperature instability, lethargy,decreased perfusion, emesis or regurgitation of food, abdominal distension,recurrent apnea, and on occasion, increased support withmechanical ventilation. Abdominal distension and emesis are morecommon than bloody stools in very preterm infants compared to terminfants.7 Abdominal radiographic findings are an integral part of Bell’scriteria. Identification of Bell’s stage I NEC (early NEC) with abdominalradiograph is challenging, as the features on abdominal radiograph(normal gas pattern or mild ileus) are non-specific. With progressionof NEC to Bell Stage IIA, the symptoms (grossly bloody stools,prominent abdominal distension, absent bowel sounds) and featureson abdominal radiographs (one or more dilated loops and focal pneumatosis)are more specific.On the other hand, the Vermont Oxford Network criteria for NECconsist of at least one physical finding (bilious gastric aspirate oremesis, abdominal distension or occult/gross blood in the stool inthe absence of anal fissure) and at least one feature on abdominalradiograph (pneumatosis intestinalis, hepatobiliary gas, or pneumoperitoneum).1 These features correspond to Bell Stage IIA or StageIIB and are not features of early NEC. Thus relying solely on abdominalradiograph for diagnosis of early NEC, as is practiced currently,has significant drawbacks especially in extremely premature infants.7Ultrasound has been suggested to improve the percentage of infantsdiagnosed with early NEC.11 However, this imaging modality is notused routinely in the diagnosis or management of NEC.As the incidence of surgical NEC and mortality from NEC continuesto be high, the literature to demonstrate the shortcomings ofabdominal radiographs and promise of abdominal ultrasound in diagnosisof NEC is reviewed.

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Sawh, Sonja C., Santosh Deshpande, Sandy Jansen, Christopher J. Reynaert, and Philip M. Jones. "Prevention of necrotizing enterocolitis with probiotics: a systematic review and meta-analysis." PeerJ 4 (October 5, 2016): e2429. http://dx.doi.org/10.7717/peerj.2429.

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ContextNecrotizing enterocolitis (NEC) is the most frequent gastrointestinal emergency in neonates. The microbiome of the preterm gut may regulate the integrity of the intestinal mucosa. Probiotics may positively contribute to mucosal integrity, potentially reducing the risk of NEC in neonates.ObjectiveTo perform an updated systematic review and meta-analysis on the efficacy and safety of probiotics for the prevention of NEC in premature infants.Data SourcesStructured searches were performed in: Medline, Embase, and the Cochrane Central Register of Controlled Trials (all via Ovid, from 2013 to January 2015). Clinical trial registries and electronically available conference materials were also searched. An updated search was conducted June 3, 2016.Study SelectionRandomized trials including infants less than 37 weeks gestational age or less than 2,500 g on probiotic vs. standard therapy.Data ExtractionData extraction of the newly-identified trials with a double check of the previously-identified trials was performed using a standardized data collection tool.ResultsThirteen additional trials (n= 5,033) were found. The incidence of severe NEC (RR 0.53 95% CI [0.42–0.66]) and all-cause mortality (RR 0.79 95% CI [0.68–0.93]) were reduced. No difference was shown in culture-proven sepsis RR 0.88 95% CI [0.77–1.00].LimitationsHeterogeneity of organisms and dosing regimens studied prevent a species-specific treatment recommendation from being made.ConclusionsPreterm infants benefit from probiotics to prevent severe NEC and death.

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Bi, Le-wee, Bei-lei Yan, Qian-yu Yang, Miao-miao Li, and Hua-lei Cui. "Which is the best probiotic treatment strategy to prevent the necrotizing enterocolitis in premature infants." Medicine 98, no. 41 (October 2019): e17521. http://dx.doi.org/10.1097/md.0000000000017521.

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